MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

Supporting the discussion were the following briefing papers:

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).  Find its web site here.…

Feds Pursue Next Regs for Surprise Billing Law

In their continuing effort to implement the complex No Surprises Act, the 2020 law that seeks to prevent consumers from receiving surprise medical bills, federal regulators are now turning their attention to how providers and payers should inform insured individuals about the costs they may incur for procedures and purchases.

Specifically, the federal agencies with jurisdiction over the law and its implementation – the Department of Health and Human Services, the federal Office of Personnel Management, the Internal Revenue Service, the Department of the Treasury, the Department of Labor, and the Employee Benefits Security Administration – have issued a request for information (RFI) seeking stakeholder comment on how to implement the No Surprises Act’s requirement that health care providers and payers give explanations of benefits and good-faith estimates of costs for services and items that are scheduled at least three days in advance to individuals who have health insurance.

Previous regulations have focused on the delivery of this information to uninsured and self-pay patients and those obtaining services from out-of-network providers.  At the time those regulations were proposed, providers and payers asked regulators to delay implementation of the law’s requirements for the provision of such information to insured patients so …

Risk Adjustment Has Impact on Medicare Readmissions Program

The use of social risk adjustment has helped reduce differences in the penalties assessed to safety-net hospitals and other hospitals by Medicare’s hospital readmissions reduction program, according to a new study.

According to the study published in the journal Health Affairs,

Seven studies found that adding social risk factors to the program’s base risk-adjustment model (which adjusts only for age, sex, and comorbidities) reduced differences in risk-adjusted readmissions and penalties between safety-net hospitals and other hospitals. Three studies found that peer grouping, the HRRP’s current approach to social risk adjustment, reduced penalties among safety-net hospitals. Two studies found that differences in risk-adjusted readmissions and penalties were further narrowed when augmentation of the base model was combined with peer grouping. Two studies showed that it is possible to adjust for social risk factors without obscuring quality differences between hospitals.

The study’s conclusion?

These findings support the use of social risk adjustment to improve provider payment equity and highlight opportunities to enhance social risk adjustment in value-based payment programs.

Learn more from the Health Affairs study “Social Risk Adjustment In The Hospital Readmissions Reduction Program: A Systematic Review And Implications For Policy” and find a summary of that analysis …

Hospital Financial Woes Continue and Will Persist

The immediate financial future for many hospitals is bleak, according to a new study.

The study, by the health care management consulting company Kaufman Hall, concludes that

  • “Margins remain depressed relative to pre-pandemic levels.”
  • “More than half of hospitals are projected to have negative
    margins through 2022.”
  • “Expenses are significantly elevated from pre-pandemic levels.”
  • “Hospitals have faced a profound financial toll.”
  • “Ultimately, U.S. hospitals are likely to face billions of dollars
    in losses in 2022 under both optimistic and pessimistic.”

The study cites the COVID-19 pandemic and inflation among the leading causes of hospitals’ financial distress.

Learn more from the Kaufman Hall report “The Current State of Hospital Finances:  Fall 2022 Update.”…

FEDERAL HEALTH POLICY UPDATE FOR THE WEEK OF SEPTEMBER 12-16

The following is the latest health policy news from the federal government for the week of September 12-16.  Some of the language used below is taken directly from government documents.

No Surprises Act

  • The Department of Health and Human Services, the federal Office of Personnel Management, the Internal Revenue Service, the Department of the Treasury, the Department of Labor, and the Employee Benefits Security Administration have issued a request for information (RFI) seeking stakeholder comment on how to implement the No Surprises Act’s requirement that health care providers and payers give explanations of benefits and good-faith estimates of costs for services and items that are scheduled at least three days in advance to individuals who have health insurance.  Previous regulations have focused on the delivery of this information to uninsured and self-pay patients and those obtaining services from out-of-network providers, but providers and payers asked regulators to delay implementation of the law’s requirements for the provision of such information to insured patients so they could address the technical infrastructure needed to transfer data effectively and in a timely manner between and among providers and payers.  Learn more this Federal Register notice.  Comments in response to the RFI are due